A 68-year-old man presents to the clinic with progressive shortness of breath over the past 3 years, which has worsened in the last 6 months. He has a chronic productive cough and reports that he can now only walk one block before becoming breathless. He smoked 40 pack-years but quit 5 years ago.

On examination, he has a BMI of 19 kg/m², pursed-lip breathing, use of accessory muscles, and decreased breath sounds bilaterally with prolonged expiratory phase. There are no crackles or wheezes. Oxygen saturation is 91% on room air. Chest X-ray shows hyperinflated lungs with flattened diaphragms. Spirometry reveals an FEV₁/FVC ratio of 0.58 and an FEV₁ of 45% predicted

. Which of the following is the most appropriate next step in the long-term management of this patient's condition?

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